Where do nursing home complaint citations least often involve harm?
In Idaho, Nevada, Maryland, Maine and California, fewer than 6% of nursing home complaint citations were graded actual harm or immediate jeopardy from August 2023 to July 2026. The national share was 12.6%.
Which state has the lowest share of complaint citations involving harm?
In Idaho, 4.0% of nursing home complaint citations from August 2023 to July 2026 were graded actual harm or immediate jeopardy, the lowest share of any state.
How do the five states with the lowest shares differ?
Idaho: immediate jeopardy far below the national figure
Inspectors found immediate jeopardy on 7 of Idaho’s 1,113 complaint citations, fewer than one in a hundred, against 5.6% of complaint citations nationally.
Nevada: low on both actual harm and immediate jeopardy
Nevada is the only state with one of the five lowest shares for both actual harm and immediate jeopardy. Its actual harm share was 3.1% and its immediate jeopardy share 1.2%, each less than half the national figure for that grade.
Maryland: many complaint citations, few involving harm
Maryland’s inspectors wrote almost six times as many complaint citations as South Dakota’s, the state with the highest share, but fewer of them involved harm, 143 to South Dakota’s 168.
Maine: the lowest in New England
Every other New England state had a higher share involving harm, from 8.8% in Connecticut to 21.4% in Rhode Island.
California: the most complaint citations of any state, at a low share
A low share still adds up in the state with the most complaint citations. California’s 1,061 citations involving harm outnumbered the 921 in the five highest-share states combined, and only Texas and Illinois had more.
Where does your state rank?
Shares range more than eightfold, from Idaho at the bottom to South Dakota, highest of the five states where nursing home complaint citations most often involved harm.
| Rank (1 = highest share) | State or territory | Complaint citations | Citations involving harm | Share involving harm |
|---|---|---|---|---|
| 50 | Idaho | 1,113 | 45 | 4.0% |
| 49 | Nevada | 482 | 21 | 4.4% |
| 48 | Maryland | 2,899 | 143 | 4.9% |
| 47 | Maine | 565 | 31 | 5.5% |
| 46 | California | 18,530 | 1,061 | 5.7% |
| 45 | Arizona | 1,072 | 67 | 6.2% |
| 44 | District of Columbia | 475 | 30 | 6.3% |
| 43 | Ohio | 9,696 | 731 | 7.5% |
| 42 | Indiana | 3,465 | 263 | 7.6% |
| 40 | Virginia | 2,385 | 192 | 8.1% |
| 40 | Oregon | 1,476 | 120 | 8.1% |
| 39 | Nebraska | 1,075 | 89 | 8.3% |
| 38 | New Mexico | 1,049 | 91 | 8.7% |
| 37 | Connecticut | 2,039 | 180 | 8.8% |
| 36 | Pennsylvania | 6,752 | 665 | 9.8% |
| 35 | New York | 3,247 | 322 | 9.9% |
| 34 | West Virginia | 1,074 | 109 | 10.1% |
| 32 | Hawaii | 245 | 26 | 10.6% |
| 32 | Georgia | 2,619 | 278 | 10.6% |
| 31 | Louisiana | 2,266 | 254 | 11.2% |
| 29 | Wisconsin | 3,862 | 450 | 11.7% |
| 29 | Arkansas | 597 | 70 | 11.7% |
| 28 | Washington | 2,428 | 287 | 11.8% |
| 27 | Michigan | 5,000 | 612 | 12.2% |
| 25 | Delaware | 689 | 88 | 12.8% |
| 25 | Montana | 671 | 86 | 12.8% |
| 24 | Iowa | 3,424 | 441 | 12.9% |
| 23 | Oklahoma | 1,728 | 228 | 13.2% |
| 22 | New Hampshire | 126 | 17 | 13.5% |
| 21 | New Jersey | 1,501 | 212 | 14.1% |
| 20 | North Dakota | 568 | 84 | 14.8% |
| 19 | Minnesota | 2,503 | 389 | 15.5% |
| 18 | Missouri | 4,256 | 668 | 15.7% |
| 17 | Kansas | 2,151 | 349 | 16.2% |
| 16 | Texas | 14,578 | 2,419 | 16.6% |
| 15 | Colorado | 1,179 | 205 | 17.4% |
| 14 | Vermont | 358 | 63 | 17.6% |
| 13 | Wyoming | 328 | 64 | 19.5% |
| 10 | Florida | 2,529 | 520 | 20.6% |
| 10 | North Carolina | 2,897 | 597 | 20.6% |
| 10 | Massachusetts | 994 | 205 | 20.6% |
| 9 | Illinois | 11,193 | 2,377 | 21.2% |
| 7 | Utah | 711 | 152 | 21.4% |
| 7 | Rhode Island | 766 | 164 | 21.4% |
| 6 | Tennessee | 816 | 210 | 25.7% |
| 5 | Alabama | 410 | 116 | 28.3% |
| 4 | South Carolina | 467 | 149 | 31.9% |
| 3 | Kentucky | 585 | 191 | 32.6% |
| 2 | Mississippi | 886 | 297 | 33.5% |
| 1 | South Dakota | 499 | 168 | 33.7% |
| Too few citations to rank | Alaska | 84 | 14 | 16.7% |
| Too few citations to rank | Guam | 0 | 0 | No complaint citations |
| Too few citations to rank | Puerto Rico | 7 | 0 | 0.0% |
| National | 131,315 | 16,610 | 12.6% |
What to ask a nursing home
Ask any home you’re considering these three questions:
- Walk me through your recent inspections. What did inspectors cite, and when?
- What did you change after each citation?
- How do you check that those changes are working, and can I see the records?
Frequently asked questions
Which states have the lowest share of nursing home complaint citations involving harm?
Idaho, Nevada, Maryland, Maine and California had the lowest state shares of nursing home complaint citations graded actual harm or immediate jeopardy from August 2023 to July 2026, each under 6%. The national share was 12.6%.
What is a nursing home complaint inspection?
A complaint inspection is a visit state inspectors make to a nursing home to investigate a complaint or an incident the home reported. Every nursing home that participates in Medicare or Medicaid also gets a full inspection about once a year.
What do “actual harm” and “immediate jeopardy” mean in a nursing home inspection?
In a nursing home inspection, actual harm means a failure that hurt a resident, and immediate jeopardy means a failure that caused, or was likely to cause, serious injury, harm, impairment or death. Inspectors give each citation a letter grade for how severe and how widespread the problem was. Medicare’s Care Compare website shows actual harm (grades G, H and I) as level 3 and immediate jeopardy (grades J, K and L) as level 4, the highest.
Does a state’s low share of complaint citations involving harm mean its nursing homes are safe?
A state’s share of complaint citations involving harm describes its complaint inspections as a whole; it says nothing about any particular nursing home. To judge one home, read its own inspection reports on Medicare’s Care Compare.
How do I check a nursing home’s inspection results?
Medicare’s Care Compare shows the inspection results of nursing homes that participate in Medicare or Medicaid, including complaint inspections and the full report for each.
Look up a nursing home on Care Compare.
How do I file a complaint against a nursing home?
You can file a complaint against a nursing home with your State Survey Agency, the state office that inspects nursing homes and investigates complaints. Anyone with a concern about a resident’s care can file, by any means the agency accepts, including phone, mail, online or in person.
Sources and downloads. These figures come from our study, Nursing home complaint citations by state: how often they involve harm. Download the ranked table or the complete state table. Source: the Centers for Medicare & Medicaid Services Health Deficiencies dataset for nursing homes. How we counted these figures.